Opinion: It's time for Quebec to catch up to Ontario on 'super nurses'

One advocate asks why Quebec super nurses are not as independent as Ontario's

Pascale Déry, Special to Montreal Gazette

Updated: March 6, 2018

Quebec Health Minister Gaétan Barrette announced in February that nurse practitioners may treat hypertension, asthma, and diabetes. Their ability to prescribe medicine has also been expanded.Joe Raedle / Getty Images

With a health-care system plagued by access problems, Quebecers should rejoice that the province is (slowly) training more specialized nurse practitioners and (grudgingly) giving them more to do. But Quebec still lags far behind Ontario, and in fact is losing ground.

Specialized nurse practitioners, also known as “super nurses”, are health-care professionals with some powers formerly restricted to medical doctors. Quebec Health Minister Gaétan Barrette announced last month that they will now be able to do things like treat hypertension, asthma, and diabetes. Their ability to prescribe medicine has also been expanded.

Though ubiquitous in Ontario for a while now, super nurses are fairly new to this province. From March 2014 to March 2017, the total number of specialized nurse practitioners in Quebec increased from 232 to 413 according to the Ordre des infirmières et infirmiers du Québec, with most of these specializing in front-line care. Almost a year later, the number that’s circulating is 475, or another 60 or so, which is about the average number of nurse practitioners we’ve added each year for the past four years.

While these increases are welcome, the change in Ontario over the past three years was from 2,379 to 3,107, which works out to some 240 more nurse practitioners per year on average. Admittedly, Ontario’s population is larger than ours, but it’s not that much larger.

We’re also still far from the health minister’s 2014 promise to have 2,000 nurse practitioners working in the province by 2024. That’s at least 1,500 more in just six years, requiring a quadrupling of Quebec’s current pace.

Beyond the limited number of specialized nurse practitioners in the province, there’s also the question of their ability to do their work unsupervised by a doctor. According to Christine Laliberté, president of the Association des infirmières praticiennes spécialisées, while the latest change is a step in the right direction, they still don’t have as much autonomy as their colleagues in other provinces.

What reason could there be for restricting super nurses in Quebec to the provision of “diagnostic hypotheses” while elsewhere in Canada they can provide honest to goodness diagnoses? Are our nurses any less super than theirs? According to Laliberté, Quebec nurse practitioners basically get the same level of training as elsewhere in Canada. Why shouldn’t they be just as independent?

Of course, there will always be some cases that require the intervention of a doctor, but many cases do not — and any super nurse unable to make that call is unworthy of the title.

The greater the number of nurse practitioners we incorporate into our health-care system, and the more we allow them to do, the more we free up the time of front-line doctors to focus on what only they can do. This seems like a no-brainer for a system like ours with such severe access problems. It’s time for our politicians to stop dragging their feet on this file.

Also, given that a nurse practitioner costs the health-care system around a third of what a general practitioner costs — and that according to certain studies, anywhere from 25 per cent to 70 per cent of the work of non-specialist doctors providing front-line care could be carried out by nurses — the potential savings to the provincial budget should not be discounted.

In the fable, the tortoise wins the race, but only because the hare gets overconfident and takes a nap. Of course, there’s no need to “win” this race, but if we want to at least make a good showing, let’s pick up the pace, and let’s allow Quebec’s super nurses to do everything their colleagues across the Ottawa River have been doing for years.

Pascale Déry is vice-president, communications and development, at MEI, an independent, non-partisan, not-for-profit research and educational organization. MEI stimulates debate on public policies in Quebec and across Canada by proposing wealth-creating reforms based on market mechanisms.

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